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Repeat Prescription Roulette

Some locum GPs are happy to prescribe repeat prescriptions, others are not, but it also depends on an individual’s appetite for risk.

However such tasks should ideally be agreed upon at the booking stage as well as the time and payment period pertaining to this. It is important to remember that once we sign a prescription we inherit the responsibility of any prescribing errors no matter how it was initiated in the first place, therefore we need to have a certain level of caution and attentiveness.There is usually not enough time to review every record for every repeat prescription we sign for. Therefore when tackling a tower of scripts I feel more comfortable working in a well-run and organised practice where medication reviews are performed regularly.

 


The GMC reported that 4.9% of GP prescriptions have an error, of these 4% were thought to be severe (One Year Practice study GMC 2012). This means that on average for every 500 prescriptions generated in surgery, one will have a severe error.


 

These are the two points for consideration when making a decision of whether to sign off or not:

Work within your level of competence

Do not sign off on drugs that you are unfamiliar with, for example methadone, signing off a batch of CDs then worrying and second guessing your decision upon completion.

Certain drugs should ideally be excluded from the repeat prescribing conveyor belt, or at least scrutinised a lot more closely such as DMARDs (methotrexate etc.), Blood monitored drugs (e.g. warfarin and lithium), addictive pain killers (Opiates), hypnotics (benzodiazepine and Z drugs), chemotherapy medication and antidepressants.

In complex cases where you are unsure you can:

  • Leave the script unsigned for the regular GP (mention these to the receptionist)
  • Delve into the records for more clarification
  • Phone the patient to get clarification
  • Discuss with script with the regular GP.

Sometimes a fresh pair of eyes is necessary as they are able to spot prescribing errors and interactions that have previously gone unnoticed.

Illustrative case:

A case published in a medical journal illustrates the potential dangers quite well.

A lady called a surgery asking for an eye antibiotic cream for her son as who previously had conjunctivitis. She recalled that it started with a C. The relatively new receptionist looked at previous list of past drugs, printed off clotrimazole cream and left in the pile of rewrites.

The GP duly signed this innocuous looking script as a part of the morning rewrites and was later having to defend a complaint made by the mother once she realised that her son had sustained a chemical burn of the cornea.

Fortunately cases such as these are relatively rare but just reminds us that the responsibility for errors generated in the chain can ultimately land on us!

Written by
Dr Imran Malik